The Numbers That Drive Our Diabetes Management

Dr. Tim Reid once asked me why I was so driven by numbers. I had just spoken at a meeting of diabetes professionals about my success in bringing my weight down from 312 pounds and a Body Mass Index (BMI) of 39.5 in February 2006 to 156 pounds and a BMI of 19.8 in May 2008.
Dr. Reid treats patient...

The issue of BMI as we age is interesting. As you note, most of us shrink. This is because the spine compacts. So let's say someone used to be 5 foot 9 with normal BMI. Now they're 5 foot 6. Does that mean they should lose weight to stay at same BMI?

I don't think so. The height part of the BMI is simply a rough estimate of how big we are. If we stretch...

The issue of BMI as we age is interesting. As you note, most of us shrink. This is because the spine compacts. So let's say someone used to be 5 foot 9 with normal BMI. Now they're 5 foot 6. Does that mean they should lose weight to stay at same BMI?

I don't think so. The height part of the BMI is simply a rough estimate of how big we are. If we stretch our spine (as with rolfing) we don't need to gain weight, and if we compact our spine, we don't need to lose weight, IMHO.

As you note, BMI doesn't work well for heavily muscled people, and I think same is true of people who have changed height in either direction, with the exception of normally growing young people who are adding bone and muscle.

I read recently (forgot where) that A1C is not very accurate. The reason...a healthy person's red blood cells may live longer than someone who is not, therefore accumulating more sugar during that time.

I have always weighed under 116 lbs at 5'3". My first a1C was 5.9. I panicked and got it down to 5.5. Currently, I am 5'3, weight about 114. I do low...

I read recently (forgot where) that A1C is not very accurate. The reason...a healthy person's red blood cells may live longer than someone who is not, therefore accumulating more sugar during that time.

I have always weighed under 116 lbs at 5'3". My first a1C was 5.9. I panicked and got it down to 5.5. Currently, I am 5'3, weight about 114. I do low carb eating and my waist is 27-29 (depending on time of day). Yes, I still hold belly fat. I'm 57 and post menopausal. BTW..when my A1C measured 5.9, my FBG was 78.

"No one knows for sure the level that active, healthy, 20-year-olds typically have"

I did a simple pub med search for "A1c normal" and found this article:

Circulating Adiponectin Levels and their Associated Factors in Young Lean Healthy Japanese Women. Full article is available online - info below is from Table 1:

82 Japanese women with BMI average 19.9 and average age 29 had A1c average of 5.2 (and average fasting BG of 93).

In fact this brand new article in Diabetes Care also pops up in the same search:

Low Hemoglobin A1c in Nondiabetic Adults: An elevated risk state?

OBJECTIVE To identify predictors of low hemoglobin A(1c) (HbA(1c)) (<5.0%) and to investigate the association of low HbA(1c) with cause-specific mortality and risk of liver disease hospitalization.

CONCLUSIONS No single cause of death appeared to drive the association between low HbA(1c) and total mortality. These results add to evidence that low HbA(1c) values may be a generalized marker of mortality risk in the general population.

Thank you. That study of young Japanese women is getting pretty close to what I was looking for.

But the question of an A1C being too low has been around ever since the ACCORD study. The issue there is what drove it too low? I'm sure that it was all the diabetes drugs they had to take. When you don't have diabetes or manage it without...

Thank you. That study of young Japanese women is getting pretty close to what I was looking for.

But the question of an A1C being too low has been around ever since the ACCORD study. The issue there is what drove it too low? I'm sure that it was all the diabetes drugs they had to take. When you don't have diabetes or manage it without drugs, you aren't driving the level down. You are leaving it down.